Social Determinants of Health in the United States: Addressing Major Health Inequality Trends for the Nation, 1935-2016.
Social Determinants of Health in the United States: Addressing Major Health Inequality Trends for the Nation, 1935-2016.
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DOI：
10.21106/ijma.236
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发表时间：
2017-01-01
影响因子：
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通讯作者：
Vedamuthu, Ivy P
中科院分区：
文献类型：
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作者：
Singh, Gopal K;Daus, Gem P;Vedamuthu, Ivy P
目的：这项研究描述了关键的人口健康概念，并根据重要的社会决定因素，如种族/民族，教育，收入，贫困，地区剥夺，失业，住房，城乡居住和地理位置，研究了1935年至2016年美国健康和医疗保健不平等的主要经验趋势。来自国家生命统计系统、国家健康访谈调查、国家儿童健康调查、美国社区调查和行为风险因素监测系统的长期趋势数据被用来检查种族/民族，卫生和保健方面的社会经济、城乡和地理不平等。使用寿命表、年龄调整率、患病率和风险比来检查健康差异，并在0.05水平进行统计学显著性检验。结果：美国人的预期寿命从1950年的69.7岁增加到2015年的78.8岁。然而，尽管总体情况有所改善，但性别和种族/族裔差距仍然很大。2015年，亚太岛民的预期寿命最高（87.7岁），非洲裔美国人的预期寿命最低（75.7岁）。农村地区的预期寿命较低，从农村地区男性的74.5岁到大都市地区女性的82.4岁不等，1990-2014年期间城乡差距扩大。婴儿死亡率在过去80年中急剧下降。然而，种族差异随着时间的推移而扩大; 2015年，黑人婴儿的死亡率是白色婴儿的2.3倍（每1,000名活产婴儿中有11.4人对4.9人）。农村地区和贫困社区的婴儿和儿童死亡率明显较高。贫穷农村社区的黑人婴儿和儿童的死亡率比富裕农村地区高出近三倍。在心血管疾病、癌症、糖尿病、慢性阻塞性肺病、艾滋病毒/艾滋病、凶杀、心理困扰、高血压、吸烟、肥胖和获得优质医疗保健方面，种族/民族、社会经济和地理差异尤其明显。尽管总体健康状况有所改善，但在一些健康指标方面，特别是在预期寿命和婴儿死亡率方面，社会差距仍然很大。各种健康结果的显著差异表明社会决定因素在预防疾病和促进健康方面的重要性，因此有必要根据社会因素对健康不平等现象进行系统和持续的监测。需要采取多部门的方法来解决美国人之间持续不断扩大的健康不平等问题。
OBJECTIVES: This study describes key population health concepts and examines major empirical trends in US health and healthcare inequalities from 1935 to 2016 according to important social determinants such as race/ethnicity, education, income, poverty, area deprivation, unemployment, housing, rural-urban residence, and geographic location.METHODS: Long-term trend data from the National Vital Statistics System, National Health Interview Survey, National Survey of Children's Health, American Community Survey, and Behavioral Risk Factor Surveillance System were used to examine racial/ethnic, socioeconomic, rural-urban, and geographic inequalities in health and health care. Life tables, age-adjusted rates, prevalence, and risk ratios were used to examine health differentials, which were tested for statistical significance at the 0.05 level.RESULTS: Life expectancy of Americans increased from 69.7 years in 1950 to 78.8 years in 2015. However, despite the overall improvement, substantial gender and racial/ethnic disparities remained. In 2015, life expectancy was highest for Asian/Pacific Islanders (87.7 years) and lowest for African-Americans (75.7 years). Life expectancy was lower in rural areas and varied from 74.5 years for men in rural areas to 82.4 years for women in large metro areas, with rural-urban disparities increasing during the 1990-2014 time period. Infant mortality rates declined dramatically during the past eight decades. However, racial disparities widened over time; in 2015, black infants had 2.3 times higher mortality than white infants (11.4 vs. 4.9 per 1,000 live births). Infant and child mortality was markedly higher in rural areas and poor communities. Black infants and children in poor, rural communities had nearly three times higher mortality rate compared to those in affluent, rural areas. Racial/ethnic, socioeconomic, and geographic disparities were particularly marked in mortality and/or morbidity from cardiovascular disease, cancer, diabetes, COPD, HIV/AIDS, homicide, psychological distress, hypertension, smoking, obesity, and access to quality health care.CONCLUSIONS AND GLOBAL HEALTH IMPLICATIONS: Despite the overall health improvement, significant social disparities remain in a number of health indicators, most notably in life expectancy and infant mortality. Marked disparities in various health outcomes indicate the underlying significance of social determinants in disease prevention and health promotion and necessitate systematic and continued monitoring of health inequalities according to social factors. A multi-sectoral approach is needed to tackle persistent and widening health inequalities among Americans.